![]() 7 Clinical examination can indicate hemodynamic instability. 4,8ĭiagnosing splenic injury involves first ruling out colon perforation and mucosal hemorrhage. 3 As a result, the knowledge of splenic complication is the best aid to early diagnosis of this condition. 7 Most cases are relatively asymptomatic immediately following the procedure. 3,4 Sedation routinely used during colonoscopy may hamper accurate interpretation of the patient’s complaints. Because splenic injury is a rare event, and some patients present with mild or late symptoms, pain may initially be attributed to the gaseous distension of the colon. 2,7ĭiagnosing this complication can be a challenge. 7 Definitive diagnosis can be delayed by a few hours to as long as 10 days. 5,7 However, some patients remain asymptomatic for 36 to 60 hours following the colonoscopy. In most cases, the onset of these symptoms occurs within 24 hours of the procedure. Hypotension, shock, decreased hemoglobin, and leukocytosis also may occur. 7 As the PA-PSRS report describes, syncope may occur. 5,7 Other symptoms include nausea, vomiting, and weakness. 2-4 Sometimes, the acute abdominal pain radiates to the left shoulder (Kehr sign). Symptoms of this complication include acute abdominal pain after colonoscopy particularly in the upper quadrants or upper left quadrant of the abdomen. Polypectomy does not appear to increase the risk of splenic injury. ![]() 4 Females are slightly more likely to incur this complication than males. 3,5 Therefore, a careful patient history prior to colonoscopy is an important method of identifying which patients are at risk for splenic injury. 2-5,7 Patients with portal hypertension or those receiving anticoagulation therapy are also at risk. Previous trauma/injury to the spleen, splenomegaly, left colonic inflammatory bowel disease, and pancreatitis all may promote adhesions between the splenic flexure of the colon and the spleen. 5 Certain medical diagnoses may also be associated with increased risk. 3,5 Repeated traction during multiple prior colonoscopies may be associated with the formation of adhesions in the area of the splenocolic ligament. Those with a history of prior abdominal surgery or of difficult colonoscopic or therapeutic procedures are more likely to develop splenic injury. 4Ĭertain patients are at increased risk for this complication. More extensive injuries have also occurred, such as splenic rupture, perisplenic clots, and hemoperitoneum. 3,4 Splenic injuries such as laceration or hematoma have also been reported. Splenic injuries after colonoscopy may include not only an avulsion of the splenic capsule, as described in the PA-PSRS report and in the literature. 7 As the report submitted to PA-PSRS indicates, this complication can occur without colon perforation. Both factors may result in splenic injury complications becoming more frequent.Ĭauses of splenic injury include: 1) tugging of adhesions between the spleen and splenic flexure of the colon 2) excessive traction upon the splenocolic ligament 3) extensive movement of the colon during difficult pass through of the colonoscope through the splenic flexure. In addition, as individuals live longer, they are likely to have multiple colonoscopies in their lifetimes. 5-6 As the population ages, the use of colonoscopy for diagnosis and screening is increasing. 1-4 Only 33 such events have been reported in the clinical literature since the complication was first reported in 1974. Splenic injury associated with colonoscopy is extremely rare but can be fatal, especially in patients with late onset of symptoms and treatment. This rare complication was identified and resolved in a timely manner, resulting in a good patient outcome. The patient progressed well thereafter and was later discharged. ![]() The patient was taken to the operating room for an exploratory laparotomy and a splenorrhaphy to repair an inch-long avulsion of the splenic lateral capsule. A CT of the abdomen revealed hemoperitoneum. Repeat testing indicated a reduction in hemoglobin and hematocrit. The patient was placed in a monitored bed and continued to complain of recurrent, crampy abdominal pain. Approximately three hours later the patient had a syncopal episode. The report involves a splenic capsule avulsion in which the patient complained of gas pain after colonoscopy. ![]() Reports have been submitted to PA-PSRS of a rare but potentially fatal complication of colonoscopy requiring immediate intervention. A Rare but Potentially Fatal Complication
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